AccountId: 011433970860
ContactId: adae5172-71f7-49e2-9627-51f78ef017ea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 362970 ms
Total Talk Time (AGENT): 170795 ms
Total Talk Time (CUSTOMER): 75193 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/adae5172-71f7-49e2-9627-51f78ef017ea_20250306T20:48_UTC.wav
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[CUSTOMER][NEUTRAL] when I was little
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] And you remember that I used to have this little place.
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. My name is [PII] calling from Cancer Healthcare Associates calling to get status on a claim.
[AGENT][NEUTRAL] OK, did you say your name is [PII]? Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Yes, ma'am, and you're needing claim status on a patient, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that, and [PII], what is your callback number please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] 1,342,330 M as in Mary L as in Larry H.
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And again that was 1,342,330, was that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And any information that I do provide for you, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service that you're calling about for him?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And total bill amount?
[CUSTOMER][NEUTRAL] 3 1118.
[AGENT][NEUTRAL] OK, so [PII], first off, this policy was not active for that data service. This is an old policy it termed 91 of 19. Let me locate.
[AGENT][NEUTRAL] Uh, the policy that's active.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], so let me give you the correct policy number that you should have for this member because this is the active policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It is 226-8576.
[AGENT][NEUTRAL] And it has an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And give me one moment to check to see if we've received the claim for your data service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And could you tell me the name of the provider group again, please?
[CUSTOMER][NEUTRAL] Uh, it's Cancer Healthcare Associates and uh rendering provider.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Or you, you need the renting provider? OK.
[AGENT][NEUTRAL] That's OK. Yeah, ma'am, that's OK. That's, that's, that's sufficient.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. So yes, ma'am, we did receive the claim for him. This claim was received on [PII].
[AGENT][NEUTRAL] It processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3521761.
[CUSTOMER][NEUTRAL] And why was it denied?
[AGENT][NEUTRAL] OK, one of the denial reasons is office visits are not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And the other code was denied.
[CUSTOMER][NEUTRAL] And what does it cover?
[AGENT][NEUTRAL] Because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] What type of uh benefit, I mean, what type of policy does he have?
[AGENT][NEUTRAL] This is a supplemental policy that does help with co-pays, deductibles, and co-insurance amounts of covered services.
[AGENT][NEUTRAL] But office visits and office treatment are not covered.
[CUSTOMER][NEUTRAL] OK, bye bye.
[CUSTOMER][NEUTRAL] OK. So like only hospital and stuff?
[AGENT][NEUTRAL] Yes, ma'am. An outpatient facility and diagnostic.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And your name was?
[AGENT][NEUTRAL] My name is [PII] and you would use my name along with today's date if you need a call reference number and Carolina also if you need a copy of this explanation of benefits we have a portal that you should be able to print that from now that you have the claim number and our website for our portal is secured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what's the portal?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so that's secure. [PII].
[AGENT][POSITIVE] Yes ma'am, that is correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else, [PII], I can help you with?
[CUSTOMER][NEUTRAL] All right, [PII].
[CUSTOMER][POSITIVE] No, that's it. Thank you so much.
[AGENT][POSITIVE] Well, you are very welcome and thank you for calling APL. I hope you have a very nice rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.